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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5112 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 5112

To amend title XVIII of the Social Security Act to provide payment for 
crisis stabilization services under the prospective payment system for 
                hospital outpatient department services.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 19, 2024

Ms. Cortez Masto (for herself and Mr. Cornyn) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
To amend title XVIII of the Social Security Act to provide payment for 
crisis stabilization services under the prospective payment system for 
                hospital outpatient department services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Crisis Care Access Act of 2024''.

SEC. 2. PAYMENT FOR CRISIS STABILIZATION SERVICES UNDER PROSPECTIVE 
              PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT 
              SERVICES.

    (a) In General.--Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended--
            (1) in paragraph (1)(B)--
                    (A) in clause (iv), by striking ``and'' at the end;
                    (B) in clause (v), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new clause:
                            ``(vi) includes crisis stabilization 
                        services (as defined in paragraph (23)) 
                        furnished on or after January 1, 2027.''; and
            (2) by adding at the end the following new paragraph:
            ``(23) Crisis stabilization services.--
                    ``(A) Crisis stabilization services defined.--In 
                this subsection, the term `crisis stabilization 
                services' means applicable items and services (as 
                defined in subparagraph (B)) that are furnished to an 
                eligible individual who is experiencing a mental health 
                or substance use disorder crisis, subject to the 
                requirements under subparagraph (C).
                    ``(B) Applicable items and services defined.--
                            ``(i) In general.--For purposes of 
                        subparagraph (A), the term `applicable items 
                        and services' means items and services 
                        described in clause (ii) that are--
                                    ``(I) covered under this part; and
                                    ``(II)(aa) reasonable and necessary 
                                for the diagnosis and active treatment 
                                of the individual's mental health or 
                                substance use disorder condition; or
                                    ``(bb) reasonably expected to 
                                support the de-escalation of the 
                                individual's mental health or substance 
                                use disorder crisis.
                            ``(ii) Items and services described.--The 
                        following items and services are described in 
                        this clause:
                                    ``(I) Observation services and 
                                supervised care for individuals in 
                                severe distress for up to 23 
                                consecutive hours.
                                    ``(II) Screening for suicide risk, 
                                including comprehensive suicide risk 
                                assessments and planning when 
                                clinically indicated.
                                    ``(III) Screening for violence 
                                risk, including comprehensive violence 
                                risk assessments and planning when 
                                clinically indicated.
                                    ``(IV) Assessment of immediate 
                                physical health needs and delivery of 
                                care for physical health needs that are 
                                within the capability of the hospital.
                                    ``(V) Such other items and services 
                                as the Secretary determines 
                                appropriate.
                    ``(C) Requirements for payment.--In order to 
                receive payment for crisis stabilization services under 
                this subsection, a hospital must document, in a form 
                and manner determined appropriate by the Secretary, 
                that--
                            ``(i) the hospital accepts referrals, 
                        within the capability of the hospital, for 
                        crisis stabilization services;
                            ``(ii) the hospital is capable of providing 
                        referrals for health, social, and other 
                        services and supports, as needed, that are not 
                        provided as part of crisis stabilization 
                        services;
                            ``(iii) the unit of the hospital that 
                        furnishes crisis stabilization services is 
                        staffed at all times (24 hours a day, 7 days a 
                        week, 365 days a year) with a multidisciplinary 
                        team, which may include providers such as a 
                        psychiatrist or psychiatric nurse practitioner 
                        (who may be available by telehealth for such 
                        staffing purposes), registered nurses, 
                        practitioners legally authorized to furnish 
                        such services under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the services are furnished, 
                        and peer support specialists (as defined in 
                        subparagraph (D)); and
                            ``(iv) the unit of the hospital that 
                        furnishes crisis stabilization services is 
                        capable--
                                    ``(I) of timely communication with 
                                emergency response systems, crisis 
                                intervention hotlines, and physicians 
                                and practitioners furnishing mobile 
                                crisis response team services (as 
                                defined in subparagraph (D)); and
                                    ``(II) within the capacity of the 
                                hospital, of accepting referrals of 
                                individuals from such entities for 
                                crisis stabilization services.
                    ``(D) Definitions.--In this paragraph:
                            ``(i) Mobile crisis response services.--The 
                        term `mobile crisis response team services' 
                        means physicians' services that are furnished 
                        outside of a hospital, other facility setting, 
                        or physician office to an individual 
                        experiencing a mental health or substance use 
                        disorder crisis to--
                                    ``(I) provide screening and 
                                assessment for the individual's mental 
                                health or substance use disorder 
                                crisis;
                                    ``(II) support the de-escalation of 
                                the individual's mental health or 
                                substance use disorder crisis;
                                    ``(III) facilitate or support 
                                subsequent referral to health, social, 
                                and other services, as determined 
                                appropriate by the Secretary; or
                                    ``(IV) otherwise address the 
                                individual's pressing behavioral health 
                                needs, as determined appropriate by the 
                                Secretary.
                            ``(ii) Peer support specialist.--The term 
                        `peer support specialist' means an individual 
                        who--
                                    ``(I) is recovering from a mental 
                                health or substance use condition; and
                                    ``(II) is certified as qualified to 
                                furnish peer support services under a 
                                certification process consistent with 
                                the National Practice Guidelines for 
                                Peer Supporters and inclusive of the 
                                Substance Abuse and Mental Health 
                                Services Administration Core 
                                Competencies for Peer Workers in 
                                Behavioral Health Settings (as 
                                established by the State in which such 
                                individual furnishes such services or 
                                under such certification process 
                                determined appropriate by the Secretary 
                                of Health and Human Services.''.
    (b) Report on Medicare Coverage of Crisis Stabilization Facility 
Services.--Not later than 18 months after the date of the enactment of 
this Act, the Secretary of Health and Human Services (referred to in 
this subsection as the ``Secretary'') shall submit to the Committee on 
Finance of the Senate and the Committee on Energy and Commerce and the 
Committee on Ways and Means of the House of Representatives a report on 
policy issues for consideration in relation to providing Medicare 
coverage of crisis stabilization services (as defined in section 
1833(t)(23) of the Social Security Act, as added by subsection (a)), 
when furnished by crisis stabilization facilities that are not eligible 
to enroll in the Medicare program as a subsection (d) hospital (as 
defined in section 1886(d)(1)(B) of such Act (42 U.S.C. 
1395ww(d)(1)(B))). Such report may include an assessment of the 
following:
            (1) Considerations relating to licensure and accreditation 
        of such facilities by States and accreditation organizations to 
        ensure care quality and program integrity.
            (2) Considerations relating to the development of payment 
        rates for such facilities, including collection of data on the 
        costs that such facilities incur in furnishing crisis 
        stabilization services.
            (3) Considerations relating to any program integrity risks 
        associated with crisis stabilization facilities and potential 
        measures that could be implemented to mitigate those risks.
            (4) Other considerations determined appropriate by the 
        Secretary.
                                 <all>
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